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Few good choices: Granite State veterans often forced pick between long drives or longer waits

Keene Sentinel - 4/23/2017

April 23--It took two months of phone calls before Bob Wheeler decided he'd had enough.

His wife, Carole Wheeler of Chesterfield, had been calling in repeatedly to Veterans Choice, a national health care program meant to connect veterans with local providers to provide faster care. She wanted to schedule an annual mammogram; she'd received a reminder from Brattleboro Memorial Hospital to do so around her birthday, Feb. 27.

It was a routine procedure that Carole Wheeler, a former Army cook, had received through her U.S. Department of Veterans Affairs (VA) health insurance for years. But circumstances had changed. When she called the hospital, she was told that the service was now being administered through the recently established Choice program. She was told the Choice program would be making arrangements for her mammogram and was given a national number to call.

Weeks later, the Wheelers found themselves at wits' end. Carole Wheeler had called the number repeatedly, receiving instructions to leave her details in a voice message and await a call back. Sometimes, the calls would be returned, only for more information to be sought and more assurances that a follow-up call could come in days.

Other times, the calls would come late, or not at all. Rarely did the same person call twice, a circumstance that meant she would have to explain her situation from the beginning each time. And the need to wait for calls caused problems for Carole Wheeler, who works during the day and couldn't always stay at home to wait by the phone.

Exasperated, Carole Wheeler tried other avenues. She reached out to her congresswoman, Rep. Ann M. Kuster, D-N.H., and spoke to a staff member dealing with veterans' issues. She wrote a letter to The Sentinel, published April 12. And she voiced increasing frustration with the people on the other end of the phone calls, each telling her to wait a little longer and keep calling back.

Then, on April 14, the Wheelers' home phone rang. Carole Wheeler wasn't at home, but Bob picked up the phone. He took the opportunity to speak his mind.

"I laid into them," Bob, himself a veteran, said. "I told them if she doesn't have an appointment by Friday, you'll be hearing from our congresswoman's office."

Twenty minutes later, the Wheelers said, Carole Wheeler got a call on her cell phone at work. The Veterans Choice employee on the other end was helpful and efficient; the problems were solved quickly. Wheeler got her mammogram last Tuesday, at the same hospital she's gone to for years.

It's a frustrating experience that still lingers in Carole's mind. "It took us forever," she said. "We were so -- so flustered."

But it's a situation the Wheelers have faced before. In December 2015, Bob Wheeler woke with extreme stomach pains and called the Choice hotline to secure a speedy appointment at Brattleboro Memorial.

Bob Wheeler was told to wait for a return call. The pain continued to grow. Soon, he was driving the hour up to the Veterans Affairs hospital in White River Junction, Vt., to seek out the emergency care himself.

Within a day, the White River hospital identified the problem and scheduled surgery to remove Wheeler's gall bladder, he said. Four days after the surgery, a Veterans Choice employee returned his initial call. They needed some more information before they could proceed.

It wasn't supposed to be this way. Created in 2014 through the Veterans Access, Choice and Accountability Act, the Veterans Choice program was meant to be an innovative fix for a health care problem that had snowballed into a scandal. After a searing CNN investigation that year revealed dozens of veterans had died awaiting care at the Phoenix Veterans Health Administration hospital, a string of veterans hospitals around the country came under scrutiny.

Negligent practices and similar deaths at other hospitals -- as well as general concern surrounding an overcrowded national system near the close of two wars -- soon came to light through media reports. The grim findings cast controversy over the Obama administration and spurred the president and Congress to work for a quick solution.

What emerged was the Veterans Choice program: a new system that would allow veterans who had waited more than 30 days to be served at their VA hospital or who lived more than 40 miles from a VA hospital to access care at local providers.

Supporters touted the program as a robust and cost-effective means to increase care options quickly. In New Hampshire, the only state in the lower 48 states that doesn't have a full-service VA hospital, the program was seen as a particular boost that could save drive times to the White River Junction facility and other hospitals in Massachusetts and Maine.

But critics, including some officials in the VA itself, warned the program was being rushed. Congress limited it to national health care providers and gave them only 90 days to develop proposals. Only two providers, Health Net Federal Services and TriWest, committed. Of the two, Health Net covers states in the Northeast, including New Hampshire.

Since the program's implementation, the criticism has not slowed. Stories of delays and bureaucratic difficulties encountered by veterans attempting to access the program have been in news reports across the country. An NPR investigation in January found that of the $10 billion originally appropriated to ease the crisis, little has been targeted directly at the hospitals that needed it the most, and staffing shortages have not been alleviated.

Responding to a Sentinel query, Molly Tuttle, a spokeswoman for Health Net, declined to comment on either of the Wheelers' cases, citing patient confidentiality. But she said that Health Net "(strives) to provide excellent service to every veteran, every time" and is aware of the concerns with delays.

"We have made improvements, but we recognize there is more to do," she said, adding that the provider is working with Congress, the Department of Veterans Affairs and the White River Junction VA to streamline care. Tuttle did not elaborate on what the solutions could entail.

Meanwhile, Congress recently attempted its own fixes for the program. On Wednesday, President Trump signed a bipartisan bill to extend the program beyond its original August expiration date and direct the program to cover veterans' bills upfront, rather than through reimbursement.

The federal department has also put out a request for proposals for additional health care providers to attempt to streamline the way the program is administered.

In statements following the Congressional extension, New Hampshire's elected representatives said they recognize the concerns with Veterans Choice, but argued that the program is worth improving, not setting aside.

Sen. Jeanne Shaheen, a Democrat and longtime proponent of the program, praised the bill extending the program, calling it "a step in the right direction." And she said she'd continue looking for solutions for the Granite State.

"For far too long New Hampshire veterans have been at an unfair disadvantage when it comes to accessing health care services, having to travel long distances for long wait times," she said in a statement, touting an effort she made to get the VA clinic established in Keene.

Rep. Kuster agreed.

"I've heard from many New Hampshire veterans who have had issues using the Choice program, which is why I continue to look for ways to improve the program and expand access to care for our veterans," she said, pointing to a new patient-centered program at White River Junction in cooperation with the Veterans Choice program as a good first step.

Back in Chesterfield, the Wheelers say their grievances aren't directed at the VA as a whole. They're happy with the care they get at the White River Junction VA, a sentiment they say many veterans share.

"I like the VA system," Carole Wheeler said. "I'm just not a Choice fan."

Speaking about the program, Bob Wheeler said the problem isn't with the funding -- "They've got the funding" -- but he said that the program should improve the way it deals with its patients and smooth out inefficiencies.

A good place to start, he said, would be to pick up the phone on time.